Medial upper eyelid crease incision approach to optic nerve sheath fenestration as part of a multidisciplinary treatment protocol for patients with vision-threatening papilledema

OBJECTIVE: The authors previously published their experience with a multidisciplinary care pathway for the treatment of vision-threatening papilledema. Many of the patients in this series underwent optic nerve sheath fenestration (ONSF) using a medial upper eyelid approach to the optic nerve. The purpose of this study was to review the authors' experience with this surgical approach and to determine if it is a safe and effective treatment option for these patients. METHODS: The authors reviewed all patients who underwent ONSF at their institution between 2014 and 2023. All charts were reviewed for any mention of serious intraoperative or postoperative complications for which patients had to undergo a subsequent neurosurgical procedure, either ventriculoperitoneal shunt placement or transverse venous sinus stenting. The authors analyzed visual acuity and visual field mean defect prior to surgery and at the first and most recent postoperative visits. RESULTS: Fifty-two patients who underwent ONSF at our institution during this time were reviewed. None of these patients experienced serious complications from the surgery. Thirteen patients subsequently underwent ventriculoperitoneal shunting and 3 subsequently underwent transverse venous sinus stenting. Visual acuity did not change significantly from baseline to the first and most recent postoperative visits. Visual field mean defect significantly improved from baseline to the first and most recent postoperative visits. CONCLUSIONS: ONSF via medial upper eyelid crease incision is a safe and effective option as part of a multidisciplinary treatment protocol for the treatment of vision-threatening papilledema.